Manufacturers Insurance Quote Form

For UK Customers Only

Please insert your details here and one of our business insurance advisers will contact you shortly.

This form is designed for quotes for single premise manufacturers insurance only. Manufacturers Insurance policies are flexible policies designed to provide cover for manufacturers the sections of cover that you require i.e. contents/plant/machinery, buildings (optional), business interruption, public/product liability, employers' liability, money, goods in transit, legal expenses cover, etc.

If you have more than one premises or require assistance when completing this form, please phone us on 01623 641 386 and we will be happy to help.

Contact/Company Details

Proposer's Full Name(s):(enter sole trader's name or all partner's names if a partnership)

Contact Name:(if different to proposer's name)

Limited Company Name:(if operating as a limited company)

Business Trading Name:(if different to the above)

Trading Status:

Are any subsidiary companiesto be included under this insurance?

Yes No

If yes, please provide the name(s) andaddress(es) of any companies you wish to include:

Business Address:

Business Postcode:

Do you have a different correspondence address?

Yes No

Correspondence Address:

Correspondence Postcode:

Daytime Telephone Number:

*E-Mail Address:

*Please note that your email address will only be used to provide you with your quote and not for any other marketing purposes.

General Information

Have you or any partner or director ever been convicted of or charged (but not yet tried) with any criminal offence?

Yes No

If yes, please provide full details:(e.g. type/reason for conviction(s),date(s) of conviction(s),details of any fines and/or community service (if applicable),length of custodial sentence(s) (if applicable),etc.)

Have you, or any partner or director ever been declared bankrupt, insolvent, the subject of awinding up order or liquidation or the subjectof any county court judgements or sheriff decrees?

Yes No

Please provide details:(e.g. date(s) of bankruptcy/insolvency/CCJ/IVA,amount of bankruptcy/insolvency/CCJ/IVA (£'s),date discharged, or please confirm if still current,circumstances of bankruptcy/insolvency/CCJ/IVA, etc.)

Have you, or any other partner or director ever been a director or partner of a company which has goneinto insolvency, liquidation, receivership or administration?

Yes No

If yes, please provide details:(e.g. name of previous company,date(s) of insolvency/liquidation/receivership/administration,reason for insolvency/liquidation/receivership, etc.)

Has any insurer ever refused renewal, declined/cancelled cover or imposed any special terms?

Are any heat processes carried out at the premises?(e.g. oxy-acetylene or similar welding or flame cutting equipment, angle grinders, blow lamps or blow torches, flame guns, hot air guns or other heat producing equipment)

Tenants Improvements Sum Insured (if required):(i.e. to insure improvements you have made as a tenantto the building's fixtures and fittings such as a new counter,suspended ceilings, partitions, lightning, decorations, etc.)

Has the business and/or its directors beeninvolved in any legal dispute, tax investigation orany other court or tribunal action in the last 5 years?

Yes No

Please provide details of the dispute including dates:

Management Liability Cover

Is directors and officers cover required?

Yes No

If yes, limit of indemnity required?

Professional Risks

Do you provide any advice, design or specification?

Yes No

If yes, do you require professional indemnity cover?

Yes No

If yes, limit of indemnity required?

Other Covers

If there is any other type of cover thatyou wish to include, please provide details:(e.g. engineering inspection, etc.)

You are required to make a fair presentation of the risk to insurers which means that you are required to disclose every material circumstance which you know or ought to know relating to the risk to be insured. Materially important information is any information that could influence an insurer's decision to accept your risk including the cost of your insurance. Failure to comply with the duty of fair presentation could mean that your policy is void or that insurers are not liable to pay all or part of your claim(s). By submitting this quotation you are confirming that there are no other material facts to disclose other than those shown above.

Details of Current/Previous Policies

Renewal date / date cover required:

(dd/mm/yyyy)

Current renewal premium / best quote (£'s):

per annum(This will help us to get you a better quote.)

Name of current / previous insurer:

(e.g. Aviva, AXA, Allianz, QBE, RSA, Zurich, etc.)

Request Manufacturers Insurance Quotation

Disclosure
Please ensure that all the information you have provided is correct and that you have answered all the questions accurately then press the 'Request Manufacturers Insurance Quotation' button to send your quotation details to us.